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ANNAPOLIS (AP) — Maryland could lose up to $75 million in federal money for Medicaid case management services designed to provide preventive health care, a change that could affect up to 200,000 residents, state health officials and advocates said yesterday.

The rules, which were drafted by the federal government’s Centers for Medicare and Medicaid Services and will affect all 50 states, are scheduled to take effect next month. The rules were made to save money by reducing abuses in the system.

John Folkemer, deputy state health secretary for Maryland, described the rules as very far-reaching during a briefing to the Maryland House Health and Government Operations Committee. He said every case management program in the state will be affected.

“Every single thing we’re doing in case management has to change, and some of them have to change significantly,” Mr. Folkemer said.

Dennis Smith, director for the federal government’s Center for Medicaid and State Operations, said the rules are needed because Medicaid money is being used to fill budget holes in county and state budgets unrelated to health. Too often, Medicaid money has been used to pay for things like juvenile justice, parole services and other things that are not directly related to health, Mr. Smith said.

“Good case management leads to better outcomes for the individual and better savings for the taxpayer in the long run,” Mr. Smith said. “That’s what our rule is really about.”

Mr. Folkemer said he didn’t think states that have been following the rules should be penalized for the actions of other states that may be abusing the system.

Michelle Hart, a Baltimore County mother of three — two of whom have disabilities — said she has serious concerns about how the regulations will affect Maryland’s Infants and Toddlers Program, which one of her children uses.

“What I’ve been left to do is actually contact my senators … and keep my fingers crossed and not hold my breath too much,” Mrs. Hart told the committee.

Gov. Martin O’Malley has written to U.S. Health and Human Services Secretary Michael O. Leavitt, urging him to reconsider the regulations, saying the quality of case management will likely be lowered.

“To come into compliance with the provisions of the rule, Maryland may be forced to leave many vulnerable populations without any access to needed case management services, or create disruptions and confusion in how they receive them,” wrote Mr. O’Malley, a Democrat.

Maryland spends a total of about $150 million on case management services, with about half of the money coming from the federal government. The new rules will end up shifting more costs onto states that decide to keep their programs intact, Mr. Folkemer said.

Comments on the policy changes are due on Monday, and Maryland already has submitted comments, but Mr. Folkemer said he thought it would take legislation to prevent the rules from taking effect.

“They think that states are somehow manipulating the system as it is now and this is what they’re committed to doing,” Mr. Folkemer said. “So I think really the only hope is that Congress will take some kind of action.”